The emergency medical systems (EMS) in Europe are of a high quality partly due to the presence of an emergency doctor at the scene. In those countries without emergency doctors in the field, the emergency medical technicians (EMT) are allowed by law to carry out medical interventions due to their special education including more than 2000 hrs of first aid training (paramedics). The efficiency of the EMS is essentially improved by the presence of paramedics, especially in connection with the increasing frequency of cardiac arrests due to the high incidence of cardiovascular disorders. In the non-European states where the mean life expectancy is low (< or = 70 a) bystander training is rarely introduced. The EMS in Austria is of European standard in the structure of the rescue chain. Some links of this chain require correction and improvement: bystander training has not yet reached its optimal expanse; the profession of an EMT has to be urgently recognized by law; the gaping difference between EMS in urban areas and rural areas has to be eliminated; the limited capacity of emergency admittance to hospitals is a weak link in the chain of survival.